Apparatus and method for cinching a straight staple line

ABSTRACT

An apparatus includes an end effector including an anvil and lower jaw. The anvil is pivotable toward the lower jaw to capture tissue. The apparatus further includes a stapling and severing assembly configured to sever and staple tissue clamped between the anvil and the lower jaw. A staple cartridge is coupled with the lower jaw. The staple cartridge includes a deck facing the anvil, a plurality of staples positioned in a plurality of staple openings formed through the deck, and a cinching feature positioned on the deck. At least a portion of the cinching feature is configured to be captured by the staples as the staples are driven out of the staple openings in response to activation of the stapling and severing mechanism. The cinching feature is configured to cinch severed and stapled tissue.

BACKGROUND

In some surgical procedures (e.g., colorectal, bariatric, thoracic,etc.), portions of a patient's digestive tract (e.g., thegastrointestinal tract and/or esophagus, etc.) may be cut and removed toeliminate undesirable tissue or for other reasons. Once the tissue isremoved, the remaining portions of the digestive tract may be coupledtogether in an end-to-end anastomosis. The end-to-end anastomosis mayprovide a substantially unobstructed flow path from one portion of thedigestive tract to the other portion of the digestive tract, withoutalso providing any kind of leaking at the site of the anastomosis.

One example of an instrument that may be used to provide an end-to-endanastomosis is a circular stapler. Some such staplers are operable toclamp down on layers of tissue, cut through the clamped layers oftissue, and drive staples through the clamped layers of tissue tosubstantially seal the layers of tissue together near the severed endsof the tissue layers, thereby joining the two severed ends of theanatomical lumen together. The circular stapler may be configured tosever the tissue and seal the tissue substantially simultaneously. Forinstance, the circular stapler may sever excess tissue that is interiorto an annular array of staples at an anastomosis, to provide asubstantially smooth transition between the anatomical lumen sectionsthat are joined at the anastomosis. Circular staplers may be used inopen procedures or in endoscopic procedures. In some instances, aportion of the circular stapler is inserted through a patient'snaturally occurring orifice.

Examples of circular staplers are described in U.S. Pat. No. 5,205,459,entitled “Surgical Anastomosis Stapling Instrument,” issued Apr. 27,1993; U.S. Pat. No. 5,271,544, entitled “Surgical Anastomosis StaplingInstrument,” issued Dec. 21, 1993; U.S. Pat. No. 5,275,322, entitled“Surgical Anastomosis Stapling Instrument,” issued Jan. 4, 1994; U.S.Pat. No. 5,285,945, entitled “Surgical Anastomosis Stapling Instrument,”issued Feb. 15, 1994; U.S. Pat. No. 5,292,053, entitled “SurgicalAnastomosis Stapling Instrument,” issued Mar. 8, 1994; U.S. Pat. No.5,333,773, entitled “Surgical Anastomosis Stapling Instrument,” issuedAug. 2, 1994; U.S. Pat. No. 5,350,104, entitled “Surgical AnastomosisStapling Instrument,” issued Sep. 27, 1994; and U.S. Pat. No. 5,533,661,entitled “Surgical Anastomosis Stapling Instrument,” issued Jul. 9,1996; and U.S. Pat. No. 8,910,847, entitled “Low Cost Anvil Assembly fora Circular Stapler,” issued Dec. 16, 2014. The disclosure of each of theabove-cited U.S. Patents is incorporated by reference herein.

Some circular staplers may include a motorized actuation mechanism.Examples of circular staplers with motorized actuation mechanisms aredescribed in U.S. Pub. No. 2015/0083772, entitled “Surgical Stapler withRotary Cam Drive and Return,” published Mar. 26, 2015; U.S. Pub. No.2015/0083773, entitled “Surgical Stapling Instrument with Drive AssemblyHaving Toggle Features,” published Mar. 26, 2015; U.S. Pub. No.2015/0083774, entitled “Control Features for Motorized Surgical StaplingInstrument,” published Mar. 26, 2015; and U.S. Pub. No. 2015/0083775,entitled “Surgical Stapler with Rotary Cam Drive,” published Mar. 26,2015. The disclosure of each of the above-cited U.S. Patent Publicationsis incorporated by reference herein.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a perspective view of an exemplary circular stapler;

FIG. 2 depicts a perspective view of the circular stapler of FIG. 1,with a battery pack removed from a handle assembly and an anvil removedfrom a stapling head assembly;

FIG. 3 depicts a perspective view of the anvil of the circular staplerof FIG. 1;

FIG. 4 depicts a perspective view of the stapling head assembly of thecircular stapler of FIG. 1;

FIG. 5 depicts an exploded perspective view of the stapling headassembly of FIG. 4;

FIG. 6 depicts an exploded perspective view of the circular stapler ofFIG. 1, with portions of the shaft assembly shown separately from eachother;

FIG. 7 depicts a schematic view of a lower portion of a patient'sgastrointestinal tract, with an endocutter stapler being utilized tostaple and sever the gastrointestinal tract at a first location and theendocutter stapler being utilized to staple and sever thegastrointestinal tract at a second location, thereby dividing thegastrointestinal tract into an upper portion, a transected portion, anda lower portion during a surgical procedure;

FIG. 8 depicts a schematic view of the gastrointestinal tract of FIG. 7during another step of the surgical procedure of FIG. 7, showing theanvil of FIG. 3 positioned in the upper portion of the gastrointestinaltract and the stapling head assembly of FIG. 4 positioned in the lowerportion of the gastrointestinal tract, with the anvil and the staplinghead assembly and adjacent regions of the gastrointestinal tract shownin cross-section;

FIG. 9 depicts a schematic view of the gastrointestinal tract of FIG. 7during another step of the surgical procedure of FIG. 7, showing theupper portion and the lower portion of the patient's gastrointestinaltract being compressed between the anvil and the stapling head assemblyof the circular stapler of FIG. 1, with the anvil and the stapling headassembly and adjacent regions of the gastrointestinal tract shown incross-section;

FIG. 10 depicts a schematic view of the gastrointestinal tract of FIG. 7upon completion of the surgical procedure of FIG. 7, with the upper andlower portions of the patient's gastrointestinal tract joined by staplesdeployed from the circular stapler of FIG. 1, providing an anastomosisbetween the upper and lower portions of the patient's gastrointestinaltract, with the anastomosis and adjacent regions of the gastrointestinaltract shown in cross-section;

FIG. 11 depicts a perspective view of an exemplary alternative staplecartridge loaded into the lower jaw of the stapling device of FIG. 7,including a suture on a deck thereof, capable of being utilized in theprocedure shown in FIGS. 7-10;

FIG. 12 depicts a side elevational view of portion of thegastrointestinal tract after having been stapled and severed utilizingthe staple cartridge of FIG. 11;

FIG. 13 depicts a side elevational view of a portion of thegastrointestinal tract after having been stapled and severed utilizinganother exemplary alternative staple cartridge;

FIG. 14 depicts a top view of the portion of the gastrointestinal tractof FIG. 12 in a contracted configuration;

FIG. 15A depicts a schematic view of severed upper and lower portions ofa patient's gastrointestinal tract, with an anvil of the circularstapler of FIG. 1 positioned in the upper portion of thegastrointestinal tract and a shaft of the circular stapler of FIG. 1positioned in the lower portion of the gastrointestinal tract, with thestaple cartridge of FIG. 11 having been used to staple and sever thegastrointestinal tract, and with the lower portion of thegastrointestinal tract in a contracted position, during a surgicalprocedure;

FIG. 15B depicts a schematic view of the gastrointestinal tract of FIG.15A during another step of the surgical procedure of FIG. 15A, showingthe upper portion and the lower portion of the patient'sgastrointestinal tract being compressed between the anvil and thestapling head assembly of the circular stapler of FIG. 1, with the anviland the stapling head assembly and adjacent regions of thegastrointestinal tract shown in cross-section;

FIG. 15C depicts a schematic view of the gastrointestinal tract of FIG.15A upon completion of the surgical procedure of FIG. 15A, with theupper and lower portions of the patient's gastrointestinal tract joinedby staples deployed from the circular stapler of FIG. 1, providing ananastomosis between the upper and lower portions of the patient'sgastrointestinal tract, with the anastomosis and adjacent regions of thegastrointestinal tract shown in cross-section;

FIG. 16 depicts a perspective view of another exemplary alternativestaple cartridge loaded into the lower jaw of the stapling device ofFIG. 7, including a suture on a deck thereof, capable of being utilizedin the procedure shown in FIGS. 7-10;

FIG. 17 depicts a side elevational view of portion of thegastrointestinal tract after having been stapled and severed utilizingthe staple cartridge of FIG. 16;

FIG. 18 depicts a schematic view of severed upper and lower portions ofa patient's gastrointestinal tract, with an anvil of the circularstapler of FIG. 1 positioned in the upper portion of thegastrointestinal tract and a shaft of the circular stapler of FIG. 1positioned in the lower portion of the gastrointestinal tract, with thestaple cartridge of FIG. 16 having been used to staple and sever thegastrointestinal tract, and with the lower portion of thegastrointestinal tract in a contracted position, during a surgicalprocedure;

FIG. 19 a perspective view of another exemplary alternative staplecartridge loaded into the lower jaw of the stapling device of FIG. 7,including an buttress on a deck thereof, capable of being utilized inthe procedure shown in FIGS. 7-10;

FIG. 20A depicts a schematic view of the gastrointestinal tract of FIG.7 during a surgical procedure, showing the anvil of FIG. 3 positioned inthe upper portion of the gastrointestinal tract and the stapling headassembly of FIG. 4 positioned in the lower portion of thegastrointestinal tract, with the staple cartridge of FIG. 19 having beenused to staple and sever the gastrointestinal tract, showing the portionof the gastrointestinal tract in a contracted position, with the anviland the stapling head assembly and adjacent regions of thegastrointestinal tract shown in cross-section;

FIG. 20B depicts a schematic view of the gastrointestinal tract of FIG.20A during another step of the surgical procedure of FIG. 20A, showingthe upper portion and the lower portion of the patient'sgastrointestinal tract being compressed between the anvil and thestapling head assembly of the circular stapler of FIG. 1, with the anviland the stapling head assembly and adjacent regions of thegastrointestinal tract shown in cross-section;

FIG. 21 depicts a schematic view of severed upper and lower portions ofa patient's gastrointestinal tract, with an anvil of the circularstapler of FIG. 1 positioned in the upper portion of thegastrointestinal tract and a shaft of the circular stapler of FIG. 1positioned in the lower portion of the gastrointestinal tract, withsuture strands being pulled through the shaft assembly of the circularstapler to contract the lower portion of the gastrointestinal tractduring a surgical procedure

FIG. 22 depicts a perspective view of another exemplary alternativestaple cartridge loaded into the lower jaw of the stapling device ofFIG. 7, including an buttress on a deck thereof, capable of beingutilized in the procedure shown in FIGS. 7-10; and

FIG. 23 depicts a schematic view of severed upper and lower portions ofa patient's gastrointestinal tract, with an anvil of the circularstapler of FIG. 1 positioned in the upper portion of thegastrointestinal tract and a shaft of the circular stapler of FIG. 1positioned in the lower portion of the gastrointestinal tract, with thestaple cartridge of FIG. 22 having been used to staple and sever thegastrointestinal tract, and with the lower portion of thegastrointestinal tract in a contracted position, during a surgicalprocedure.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the technology may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presenttechnology, and together with the description serve to explain theprinciples of the technology; it being understood, however, that thistechnology is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

I. OVERVIEW OF EXEMPLARY CIRCULAR STAPLING SURGICAL INSTRUMENT

FIGS. 1-2 depict an exemplary surgical circular stapling instrument (10)that may be used to provide an end-to-end anastomosis between twosections of an anatomical lumen such as a portion of a patient'sdigestive tract. Instrument (10) of this example comprises a handleassembly (100), a shaft assembly (200), a stapling head assembly (300),an anvil (400), and a removable battery pack (120). Each of thesecomponents will be described in greater detail below. It should beunderstood that, in addition to or in lieu of the following, instrument(10) may be further constructed and operable in accordance with at leastsome of the teachings of U.S. patent application Ser. No. 14/751,506,entitled “Anvil Stabilization Features for Surgical Stapler,” filed Jun.26, 2015; U.S. Pat. Nos. 5,205,459; 5,271,544; 5,275,322; 5,285,945;5,292,053; 5,333,773; 5,350,104; 5,533,661; and/or U.S. Pat. No.8,910,847, the disclosures of which are incorporated by referenceherein. Still other suitable configurations will be apparent to one ofordinary skill in the art in view of the teachings herein.

A. Exemplary Tissue Engagement Features of Circular Stapling Instrument

As best seen in FIG. 3, anvil (400) of the present example comprises ahead (410) and a shank (420). Head (410) includes a proximal surface(412) that defines a plurality of staple forming pockets (414). Stapleforming pockets (414) are arranged in two concentric annular arrays inthe present example. Staple forming pockets (414) are configured todeform staples as the staples are driven into staple forming pockets(414) (e.g., deforming a generally “U” shaped staple into a “B” shape asis known in the art). Shank (420) defines a bore or lumen (422) andincludes a pair of pivoting latch members (430) positioned in bore(422). Each latch member (430) includes features that allows anvil (400)to be removably secured to a trocar (330) of stapling head assembly(300) as will be described in greater detail below. It should beunderstood, however, that anvil (400) may be removably secured to atrocar (330) using any other suitable components, features, ortechniques.

Stapling head assembly (300) is located at the distal end of shaftassembly (200). As shown in FIGS. 1-2, anvil (400) is configured toremovably couple with shaft assembly (200), adjacent to stapling headassembly (300). As will be described in greater detail below, anvil(400) and stapling head assembly (300) are configured to cooperate tomanipulate tissue in three ways, including clamping the tissue, cuttingthe tissue, and stapling the tissue. As best seen in FIGS. 4-5, staplinghead assembly (300) of the present example comprises a tubular casing(310) housing a slidable staple driver member (350). A cylindraceousinner core member (312) extends distally within tubular casing (310).Tubular casing (310) is fixedly secured to an outer sheath (210) ofshaft assembly (200), such that tubular casing (310) serves as amechanical ground for stapling head assembly (300).

Trocar (330) is positioned coaxially within inner core member (312) oftubular casing (310). Trocar (330) is operable to translate distally andproximally relative to tubular casing (310) in response to rotation of aknob (130) located at the proximal end of handle assembly (100). Trocar(330) comprises a shaft (332) and a head (334). Head (334) includes apointed tip (336) and an inwardly extending proximal surface (338). Head(334) and the distal portion of shaft (332) are configured for insertionin bore (422) of anvil (420). Proximal surface (338) is configured tocomplement features of latch members (430) to provide a snap fit betweenanvil (400) and trocar (330).

Staple driver member (350) is operable to actuate longitudinally withintubular casing (310) in response to activation of motor (160) as will bedescribed in greater detail below. Staple driver member (350) includestwo distally presented concentric annular arrays of staple drivers(352). Staple drivers (352) are arranged to correspond with thearrangement of staple forming pockets (414) described above. Thus, eachstaple driver (352) is configured to drive a corresponding staple into acorresponding staple forming pocket (414) when stapling head assembly(300) is actuated. Staple driver member (350) also defines a bore (354)that is configured to coaxially receive core member (312) of tubularcasing (310).

A cylindraceous knife member (340) is coaxially positioned within stapledriver member (350). Knife member (340) includes a distally presented,sharp circular cutting edge (342). Knife member (340) is sized such thatknife member (340) defines an outer diameter that is smaller than thediameter defined by the inner annular array of staple drivers (352).Knife member (340) also defines an opening that is configured tocoaxially receive core member (312) of tubular casing (310).

A deck member (320) is fixedly secured to tubular casing (310). Deckmember (320) includes a distally presented deck surface (322) definingtwo concentric annular arrays of staple openings (324). Staple openings(324) are arranged to correspond with the arrangement of staple drivers(352) and staple forming pockets (414) described above. Thus, eachstaple opening (324) is configured to provide a path for a correspondingstaple driver (352) to drive a corresponding staple through deck member(320) and into a corresponding staple forming pocket (414) when staplinghead assembly (300) is actuated. It should be understood that thearrangement of staple openings (322) may be modified just like thearrangement of staple forming pockets (414) as described above. Itshould also be understood that various structures and techniques may beused to contain staples within stapling head assembly (300) beforestapling head assembly (300) is actuated. Deck member (320) defines aninner diameter that is just slightly larger than the outer diameterdefined by knife member (340). Deck member (320) is thus configured toallow knife member (340) to translate distally to a point where cuttingedge (342) is distal to deck surface (322).

FIG. 6 shows various components of shaft assembly (200), which extendsdistally from handle assembly (100) and couples components of staplinghead assembly (300) with components of handle assembly (100). Inparticular, and as noted above, shaft assembly (200) includes an outersheath (210) that extends between handle assembly (100) and tubularcasing (310). In the present example, outer sheath (210) is rigid andincludes a preformed curved section that is configured to facilitatepositioning of stapling head assembly (300) within a patient's colon.

Shaft assembly (200) further includes a trocar actuation rod (220) and atrocar actuation band assembly (230). The distal end of trocar actuationband assembly (230) is fixedly secured to the proximal end of trocarshaft (332). The proximal end of trocar actuation band assembly (230) isfixedly secured to the distal end of trocar actuation rod (220), suchthat trocar (330) will translate longitudinally relative to outer sheath(210) in response to translation of trocar actuation band assembly (230)and trocar actuation rod (220) relative to outer sheath (210). Trocaractuation band assembly (230) is configured to flex such that trocaractuation band assembly (230) may follow along the preformed curve inshaft assembly (200) as trocar actuation band assembly (230) istranslated longitudinally relative to outer sheath (210). However,trocar actuation band assembly (230) has sufficient column strength andtensile strength to transfer distal and proximal forces from trocaractuation rod (220) to trocar shaft (332). Trocar actuation rod (220) isrigid. A clip (222) is fixedly secured to trocar actuation rod (220) andis configured to cooperate with complementary features within handleassembly (100) to prevent trocar actuation rod (220) from rotatingwithin handle assembly (100) while still permitting trocar actuation rod(220) to translate longitudinally within handle assembly (100). Trocaractuation rod (220) further includes a coarse helical threading (224)and a fine helical threading (226).

Shaft assembly (200) further includes a stapling head assembly driver(240) that is slidably received within outer sheath (210). The distalend of stapling head assembly driver (240) is fixedly secured to theproximal end of staple driver member (350). The proximal end of staplinghead assembly driver (240) is secured to a drive bracket (250) via a pin(242). It should therefore be understood that staple driver member (350)will translate longitudinally relative to outer sheath (210) in responseto translation of stapling head assembly driver (240) and drive bracket(250) relative to outer sheath (210). Stapling head assembly driver(240) is configured to flex such that stapling head assembly driver(240) may follow along the preformed curve in shaft assembly (200) asstapling head assembly driver (240) is translated longitudinallyrelative to outer sheath (210). However, stapling head assembly driver(240) has sufficient column strength to transfer distal forces fromdrive bracket (250) to staple driver member (350).

B. Exemplary User Input Features of Circular Stapling Instrument

As shown in FIG. 1, handle assembly (100) includes a pistol grip (112)and several components that are operable to actuate anvil (400) andstapling head assembly (300). In particular, handle assembly (100)includes knob (130), a safety trigger (140) a firing trigger (150), amotor (160), and a motor activation module (180). Knob (130) is coupledwith trocar actuation rod (220) via a nut (not shown), such that coarsehelical threading (224) will selectively engage a thread engagementfeature within the interior of the nut; and such that fine helicalthreading (226) will selectively engage a thread engagement featurewithin the interior of knob (130). These complementary structures areconfigured such that trocar actuation rod (220) will first translateproximally at a relatively slow rate, then translate proximally at arelatively fast rate, in response to rotation of knob (130).

It should be understood that when anvil (400) is coupled with trocar(330), rotation of knob (130) will provide corresponding translation ofanvil relative to stapling head assembly (300). It should also beunderstood that knob (130) may be rotated in a first angular direction(e.g., clockwise) to retract anvil (400) toward stapling head assembly(300); and in a second angular direction (e.g., counterclockwise) toadvance anvil (500) away from stapling head assembly (300). Knob (130)may thus be used to adjust the gap distance between opposing surfaces(412, 322) of anvil (400) and stapling head assembly (300) until asuitable gap distance has been achieved.

Firing trigger (150) is operable to activate motor (160) to therebyactuate stapling head assembly (300). Safety trigger (140) is operableto selectively block actuation of firing trigger (150) based on thelongitudinal position of anvil (400) in relation to stapling headassembly (300). Handle assembly (100) also includes components that areoperable to selectively lock out both triggers (140, 150) based on theposition of anvil (400) relative to stapling head assembly (300). Whentriggers (140, 150) are locked out, firing trigger (150) is preventedfrom initiating actuation of stapling head assembly (300). Thus, trigger(150) is only operable to initiate actuation of stapling head assembly(300) when the position of anvil (400) relative to stapling headassembly (300) is within a predefined range.

In the present example, firing trigger (150) of the present exampleincludes an integral actuation paddle, such as the paddle shown anddescribed in U.S. patent application Ser. No. 14/751,231, entitled“Surgical Stapler with Reversible Motor,” filed Jun. 26, 2015, thedisclosure of which is incorporated by reference herein. The paddle isconfigured to actuate a switch of motor activation module (180) (FIG. 1)when firing trigger (150) is pivoted to a fired position. Motoractivation module (180) is in communication with battery pack (120) andmotor (160), such that motor activation module (180) is configured toprovide activation of motor (160) with electrical power from batterypack (120) in response to the paddle actuating the switch of motoractivation module (180). Thus, motor (160) will be activated when firingtrigger (150) is pivoted. This activation of motor (160) will actuatestapling head assembly (300) as described in greater detail below.

Battery pack (120) is operable to provide electrical power to a motor(160) as noted above. Battery pack (120) may be removably coupled withhandle assembly (100) through a snap fit or in any other suitablefashion. It should be understood that battery pack (120) and handleassembly (100) may have complementary electrical contacts, pins andsockets, and/or other features that provide paths for electricalcommunication from battery pack (120) to electrically powered componentsin handle assembly (100) when battery pack (120) is coupled with handleassembly (100). It should also be understood that, in some versions,battery pack (120) is unitarily incorporated within handle assembly(100) such that battery back (120) cannot be removed from handleassembly (100).

C. Exemplary Anastomosis Procedure with Circular Stapling Instrument

FIGS. 7-10 show an exemplary surgical procedure for providing a surgicalanastomosis using instrument (10). In various instances, an anastomosismay be performed to remove a section of a patient's gastrointestinal(GI) tract. In the present example, multiple portions of a patient'scolon are severed and stapled to resect a diseased portion (C′) of thecolon (C). The remaining severed and stapled portions of colon (C) arethen anastomosed together, as discussed in further detail below.

As shown in FIG. 7, multiple endocutter staplers (1000) may be insertedinto a patient to sever and staple portions of the patient's colon (C).By way of example only, endocutter staplers (1000) may be constructedand operable in accordance with at least some of the teachings of U.S.Pat. No. 4,805,823, entitled “Pocket Configuration for Internal OrganStaplers,” issued Feb. 21, 1989; U.S. Pat. No. 5,415,334, entitled“Surgical Stapler and Staple Cartridge,” issued May 16, 1995; U.S. Pat.No. 5,465,895, entitled “Surgical Stapler Instrument,” issued Nov. 14,1995; U.S. Pat. No. 5,597,107, entitled “Surgical Stapler Instrument,”issued Jan. 28, 1997; U.S. Pat. No. 5,632,432, entitled “SurgicalInstrument,” issued May 27, 1997; U.S. Pat. No. 5,673,840, entitled“Surgical Instrument,” issued Oct. 7, 1997; U.S. Pat. No. 5,704,534,entitled “Articulation Assembly for Surgical Instruments,” issued Jan.6, 1998; U.S. Pat. No. 5,814,055, entitled “Surgical ClampingMechanism,” issued Sep. 29, 1998; U.S. Pat. No. 6,978,921, entitled“Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism,”issued Dec. 27, 2005; U.S. Pat. No. 7,000,818, entitled “SurgicalStapling Instrument Having Separate Distinct Closing and FiringSystems,” issued Feb. 21, 2006; U.S. Pat. No. 7,143,923, entitled“Surgical Stapling Instrument Having a Firing Lockout for an UnclosedAnvil,” issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled “SurgicalStapling Instrument Incorporating a Multi-Stroke Firing Mechanism with aFlexible Rack,” issued Dec. 4, 2007; U.S. Pat. No. 7,367,485, entitled“Surgical Stapling Instrument Incorporating a Multistroke FiringMechanism Having a Rotary Transmission,” issued May 6, 2008; U.S. Pat.No. 7,380,695, entitled “Surgical Stapling Instrument Having a SingleLockout Mechanism for Prevention of Firing,” issued Jun. 3, 2008; U.S.Pat. No. 7,380,696, entitled “Articulating Surgical Stapling InstrumentIncorporating a Two-Piece E-Beam Firing Mechanism,” issued Jun. 3, 2008;U.S. Pat. No. 7,404,508, entitled “Surgical Stapling and CuttingDevice,” issued Jul. 29, 2008; U.S. Pat. No. 7,434,715, entitled“Surgical Stapling Instrument Having Multistroke Firing with OpeningLockout,” issued Oct. 14, 2008; U.S. Pat. No. 7,721,930, entitled“Disposable Cartridge with Adhesive for Use with a Stapling Device,”issued May 25, 2010; U.S. Pat. No. 8,408,439, entitled “SurgicalStapling Instrument with An Articulatable End Effector,” issued Apr. 2,2013; and U.S. Pat. No. 8,453,914, entitled “Motor-Driven SurgicalCutting Instrument with Electric Actuator Directional Control Assembly,”issued Jun. 4, 2013. The disclosure of each of the above-cited U.S.Patents is incorporated by reference herein.

In the example shown, endocutter staplers (1000) are inserted into thebody laparoscopically via respective trocars. Endocutter stapler (1000)comprises a shaft (1120) and an end effector (1110) extending from theshaft (1120). End effector (1110) comprises a first jaw (1112) and asecond jaw (1114). First jaw (1112) comprises a staple cartridge (1140).Staple cartridge (1140) is insertable into and removable from first jaw(1112), though some variations may provide a staple cartridge that isnot removable from (or at least readily replaceable from) first jaw(1112). Second jaw (1114) comprises an anvil (1130) that is configuredto deform staples ejected from staple cartridge (1140). Second jaw(1114) is pivotable relative to first jaw (1112), though some variationspay provide first jaw (1112) as being pivotable relative to the secondjaw (1114). Endocutter staplers (1000) may be configured ad operable inaccordance with at least some of the teachings of U.S. Pub. No.2013/0168435, entitled “Surgical Stapling Instrument with anArticulatable End Effector,” published Jul. 4, 2013, the disclosure ofwhich is incorporated by reference. While end effector (1110) isstraight and is thus configured to apply a straight line of staples(185) in the present example, in other examples end effector (1110) maybe curved and may thus apply a curved line of staples (185).

Anvil (1130) of endocutter stapler (1000) can be opened such that anvil(1130) and staple cartridge (1140) of endocutter stapler (1000) arepositioned relative to the patient's colon (C). When anvil (1130) ismoved into a closed position, anvil (1130) clamps the colon (C) againststaple cartridge (1140). Turning now to FIG. 7, endocutter stapler(1000) can be operated to sever and staple the colon (C) at a first, orupper, location. In the example shown, three linear rows of staples(185) are implanted on the upper side of the severed upper portion (UC)of colon (C) and three rows of the staples (185) are implanted in theadjacent region of the diseased portion (C′) of the colon (C). The sameendocutter stapler (1000) (if reloaded with another cartridge (1140)),or another endocutter stapler (1000), can be operated to sever andstaple the colon (C) at a second, or lower, location. In the presentexample, three linear rows of staples (285) implanted on the lower sideof the severed lower portion (LC) of the colon (C) and three rows ofstaples (285) are implanted in the adjacent region of the diseasedportion (C′) of the colon (C). However, in other examples, othersuitable configurations of staples may be implanted onto the upperportion (UC) and/or the lower portion (LC) of the colon (C). Once thecolon (C) has been transected and stapled at the upper location and thelower location, the diseased portion (C′) of the colon can be removedfrom the patient, as illustrated in FIGS. 8-10.

Referring again to FIGS. 8-9, circular stapler (10) may be utilized toanastomose the upper portion (UC) and the lower portion (LC) of thecolon (C). An operator inserts a portion of shaft (210) and staplinghead assembly (300) into the rectum (R) of the patient into the lowerportion (LC) of the colon (C). In the example shown, a user then insertstrocar (330) through the rows of staples (285). Trocar (330) of circularstapler (10) may then be positioned in the upper portion of the colon C.In various instances, the sidewall of the upper portion of the colon Ccan be incised and trocar (330) can then be positioned inside the upperportion. Anvil (400) may then be directed into the upper portion of thecolon (C) and connected to trocar (330) in the manner discussed aboveand as shown in FIG. 8.

The operator may then draw anvil (400) toward stapling head assembly(300), in the manner described above (e.g., utilizing knob (130), thusalso drawing the upper colon portion (UC) toward the lower colon portion(LC). The operator may then retract trocar (330) until the tissue of theupper colon portion (UC) and the lower colon portion (LC) are compressedagainst deck (320) as shown in FIG. 9. It should also be understood thatknob (130) may be rotated in a first angular direction (e.g., clockwise)to retract anvil (400) toward stapling head assembly (300); and in asecond angular direction (e.g., counterclockwise) to advance anvil (400)away from stapling head assembly (300). Knob (130) may thus be used toadjust the gap distance between opposing surfaces of anvil (400) andstapling head assembly (300) until a suitable gap distance has beenachieved, such as in the manner discussed in U.S. patent applicationSer. No. 14/751,506, the disclosure of which is incorporated byreference herein. As shown in FIG. 9, flap regions (FR) are formed inthe lower portion (LC) of the colon (C) as anvil (400) is drawn towardstapling head assembly (300). These flap regions (FR) extend outwardlyfrom the region of tissue compressed between anvil (400) and staplinghead assembly (300).

As discussed above, stapling head assembly (300) is configured to applyannular arrays of staples (385) in the tissue captured between anvil(400) and stapling head assembly (300). Knife member (340) is advancedtoward anvil (440) to sever the tissue positioned radially inwardly withrespect to the annular arrays of staples (385) applied by circularstapling instrument (10). After the staples (385) have been fired andtissue has been severed, anvil (400) and stapling head assembly (300)may together be withdrawn from the patient's rectum (R). The incisionthat was used to insert anvil (400) into the upper portion (UC) of thecolon (C) may be closed via suturing or using any other suitabletechnique.

As shown in FIG. 10, the upper portion (UC) of the colon (C) and thelower portion (LC) of the colon (C) are held together by the annulararray of staples (385) deployed by circular stapling instrument (10).The deployed annular array of staples (385) forms an anastomosis (A)that allows fluid tight communication from the upper portion (UC) of thecolon (C) to the lower portion (LC) of the colon (C). Some of staples(285) that were deployed by endocutter stapler (1000) will be removedwith the tissue that was transected by knife member (340) duringactuation of stapling head assembly (300). However, in this example,there are some staples (285) remaining in the outwardly projecting flapregions (FR) in the lower portion (LC) of the colon (C), outside of theanastomosis (A). This is due to the fact that the flap regions (FR)define a width (a) that is substantially greater than the diameter (b)of knife member (340), as best seen in FIG. 9. The flap regions (FR) maynevertheless remain sealed by those remaining staples (285).

II. EXEMPLARY ALTERNATIVE STAPLE CARTRIDGES

In some instances, staples (385) that were deployed by circular staplinginstrument (10) may overlap with at least some of staples (285) thatwere deployed by endocutter stapler (1000) in the procedure describedabove with reference to FIGS. 7-10. Such overlap may prevent properformation of staples (385), which may compromise the integrity ofanastomosis (A) in the long term. In addition or in the alternative, atleast some of staples (285) that were deployed by endocutter stapler(1000) may interfere with compression of tissue between anvil (400) anddeck member (320) and/or the traversal of knife member (340) through thetissue, which may also compromise the integrity of anastomosis (A) inthe long term. Furthermore, there may be instances where the sealprovided by staples (285) in flap regions (FR) of the lower portion (LC)of the colon (C) may eventually fail over time. It may therefore bedesirable to provide features that prevent the outward extension of flapregions (FR) and position all of staples (285) and flap regions (FR)within the diameter (b) of knife member (340). Various examples of suchfeatures will be described in greater detail below.

A. Exemplary Alternative Staple Cartridge Including Suture and SutureRetainers

FIG. 11 shows an exemplary alternative staple cartridge (540) insertedin first jaw (1112) of end effector (1110). Staple cartridge (540) issubstantially similar to staple cartridge (1140), except that staplecartridge (540) includes two rows of staple cavities (545) on each sideof slot (560) of instead of three rows. Therefore, when staple cartridge(540) is incorporated into end effector (1110), two rows of staples(585) are implanted onto opposing, severed portions of tissue ratherthan three rows of staples (585). Moreover, staple cartridge (540)includes a suture assembly (580) on each side of slot (560). Each sutureassembly comprises a length of suture (582), a proximal suture retainer(584 a), a middle suture retainer (584 b), and a distal suture retainer(584 c). In the present example, suture (582) comprises any suitablemonofilament or polyfilament material as will be apparent to personsskilled in the art in view of the teachings herein.

In the example shown, at least a portion of suture assembly (580) isremovably adhered to cartridge deck (541). However, in other examples,suture assembly (580) may be affixed to cartridge deck (541) accordingto other suitable methods. As shown, each suture (582) extends alongcartridge deck (541) in a wave-like configuration such that the suture(582) extends over alternating staple cavities (545) nearest the outeredges of jaw (1112). Suture (582) slidably extends through proximal anddistal suture retainers (584, 584 c), with the free ends (586) of suture(582) passing through middle suture retainer (584 b) in a crisscrossconfiguration. Suture (582) thus forms a loop. It should be understoodthat only one half of the loop formed by suture (582) passes throughmiddle suture retainer (584 b) to reach distal suture retainers (584,584 c); while the other half of the loop formed by suture (582) does notpass through middle suture retainer (584 b) to reach distal sutureretainers (584, 584 c). This relationship is best seen in FIG. 12, whichshows suture assembly (580) deployed in tissue. It should be understoodthat the half of the loop formed by suture (582) that passes throughmiddle suture retainer (584 b) to reach distal suture retainers (584,584 c) is spaced laterally away from staple cavities (545). Thus, whenstaple cartridge (540) is actuated, staples (585) will not engage thehalf of the loop formed by suture (582) that passes through middlesuture retainer (584 b).

Middle suture retainer (584 b) includes internal features that allowfree ends (586) to be pulled away from middle suture retainer (584),thereby allowing an operator to reduce the length of the loop formed bysuture (582); yet those internal features of middle suture retainer (584b) prevent the free ends (586) to be pulled back through middle sutureretainer (584). In other words, middle suture retainer (584 b) providesone-way passage for each free end (586), only allowing the length of theloop formed by suture (582) to be reduced; without allowing the lengthof the loop formed by suture (582) to be increased. Various suitableforms that may be used to form the internal structures of middle sutureretainer (584 b) in order to provide such functionality will be apparentto those of ordinary skill in the art in view of the teachings herein.

As end effector (1100) containing staple cartridge (540) is actuated,drivers of staple cartridge (540) eject staples (585) out of cavities(545) toward anvil (1130), causing portions of suture (582) overlyingcavities (545) to be captured by crowns of staples (585). Thus, asstaples (585) are formed, portions of suture (582) are captured amongstthe formed staples (585) and coupled to the severed and stapled tissue,as shown in FIG. 12. In the example shown, suture (582) is coupled tothe tissue via alternating (i.e., every other) staple crowns such thatsuture (582) may slide relative to staples (585) and tissue. Sutureretainers (584 a, 584 c) are also secured to the tissue in this example.In particular, suture retainers (584 a, 584 c) are secured to the outerends of flap regions (FR) are formed in the lower portion (LC) of thecolon (C). By way of example only, suture retainers (584 a, 584 c) mayinclude cleats, barbs, adhesive, and/or other features that assist insecuring suture retainers (584 a, 584 c) to the tissue in response toclamping of the tissue in end effector (1100). Various suitable ways inwhich suture retainers (584 a, 584 c) may be secured to the tissue willbe apparent to those of ordinary skill in the art in view of theteachings herein. In the present example, middle suture retainer (584 b)is not secured to the tissue, though middle suture retainer (584 b) maybe secured to tissue in some other versions.

After staples (585), and suture assembly (580) have been applied totissue as shown in FIG. 12, the operator may pull free ends (586)outwardly to shorten the length of the loop formed by suture (582). Asthe operator does this, suture (582) slides through suture retainers(584 a, 584 b, 584 c) and along the space between the crowns of staples(585) and adjacent tissue. As the loop formed by suture (582) isshortened, the associated tissue is pulled inwardly in a pleated,bunched up configuration as shown in FIG. 14. As a result of thisbunching up of tissue, the flap regions (FR) are drawn inwardly suchthat the tissue has an effective width (c). This effective width (c) issmaller than the diameter (b) of knife member (340), such that staples(585), suture assembly (580), and flap regions (FR) are all positionedwithin the cylindrical plane defined by knife member (340).

FIGS. 15A-15C show steps of an anastomosis procedure similar to theprocedure shown in FIGS. 7-10. Upper colon portion (UC) and lower colonportion (LC) are shown to have been severed and stapled in a similarmanner to that shown in FIGS. 7-8. However, at least the lower colonportion (LC) has been severed and stapled utilizing staple cartridge(540). Lower colon portion (LC) therefore includes staples (585) andsuture assembly (580) coupled thereto in the manner discussed above. Asshown, a portion of shaft (210) and stapling head assembly (300) areinserted into the rectum (R) of the patient and into the lower portion(LC) of the colon (C). In the example shown, trocar (330) is insertedthrough the line of staples (585) such that trocar (330) is exposed outof lower colon portion (LC). Anvil (400) is shown to be positioned inthe upper portion (UC) of the colon (C), with shank (420) extendingthrough an opening of the upper colon portion (UC). As shown in FIG.15A, ends (586) of suture (582) have been drawn away from trocar (330),resulting in the line of staples (585) and portion of the lower colonportion (LC) being drawn radially inwardly toward trocar (330). Thus,the tissue has an effective width (c) that is smaller than the diameter(b) of knife member (340), such that staples (585), suture assembly(580), and flap regions (FR) are all positioned within the cylindricalplane defined by knife member (340).

The operator then connects shank (420) to trocar (330) in the mannerdiscussed above. Alternatively, the operator may draw the tissue oflower colon portion (LC) and the line of staples (585) radially inwardlyafter shank (420) and trocar (330) are coupled to one another. Referringto FIG. 15B, the operator may then draw anvil (400) toward stapling headassembly (300), in the manner described above (e.g., utilizing knob(130)), thus also drawing the upper colon portion (UC) toward the lowercolon portion (LC). The operator may then retract trocar (330) until thetissue of the upper colon portion (UC) and the lower colon portion (LC)are compressed against the deck member (320) to achieve a desirable gapdistance, as shown in FIG. 15B and discussed above.

The operator may then actuate trigger (150) to actuate stapling headassembly (300), resulting in the stapling and severing of tissue in asimilar manner as shown in FIG. 9. Due to the staples (585), sutureassembly (580), and flap regions (FR) all being positioned within thecylindrical plane defined by knife member (340), the combination ofstaples (585), suture assembly (580), and flap regions (FR) are allsevered from the adjacent tissue. Thus, no staples (585) or componentsof suture assembly (580) are disposed in the tissue that remains at theresulting anastomosis (A) site as shown in FIG. 15C. Moreover, staples(585) do not impede the successful operation of circular stapler (10),and there are no flap regions (FR) extending outwardly from theanastomosis (A) site. The severed portion of tissue including staples(585) and suture assembly (580) may be removed by the operator via thepatient's rectum.

FIG. 13 shows an exemplary alternative suture assembly (590) secured tothe tissue of a lower colon section (LC). It should be understood thatsuture assembly (590) may be readily incorporated into staple cartridge(540) in place of suture assembly (580). Suture assembly (590) of thisexample comprises a proximal suture retainer (594 a), a middle sutureretainer (594 b), and a distal suture retainer (594 c). Suture assembly(590) further comprises a first strand (592) and a second strand (593),which is separate from first strand (592). One end of first strand (592)is fixedly secured to proximal suture retainer (594 a), while a free end(596) of first strand (592) slidably passes through middle sutureretainer (594 b). One end of second strand (593) is fixedly secured todistal suture retainer (594 c), while a free end (597) of first strand(592) slidably passes through middle suture retainer (594 b). Strands(592, 593) pass through middle suture retainer (594 b) in a crisscrossconfiguration. Strands (592, 593) are also arranged in a wave-likepattern and are positioned to be captured between crowns of staples(585) and adjacent tissue.

Middle suture retainer (594 b) includes one-way passage features justlike middle suture retainer (584 b) described above. Thus, middle sutureretainer (594 b) allows free ends (596, 597) to be pulled outwardly toallow the length of strands (592, 593) to be shortened between middlesuture retainer (594 b) and corresponding suture retainers (594 a, 594c); yet middle suture retainer (594 b) prevents free ends (596, 597)from being pulled inwardly to increase the length of strands (592, 593)between middle suture retainer (594 b) and corresponding sutureretainers (594 a, 594 c). It should therefore be understood that sutureassembly (590) may be deployed and operated just like suture assembly(580), to create a bunched-up tissue configuration to ensure thatstaples (585) and flap regions (FR) are located within the cylindricalplane defined by knife member (340).

B. Exemplary Alternative Staple Cartridge Including Suture and StapleWeave

FIG. 16 shows an exemplary alternative staple cartridge (640) insertedin first jaw (1112) of end effector (1110). Staple cartridge (640) issubstantially similar to staple cartridge (1140), except that staplecartridge (640) includes two rows of staple cavities (645) on each sideof slot (660) of instead of three rows. Moreover, staple cartridge (640)includes a length of suture (682) on each side of slot (660). In thepresent example, suture (682) comprises any suitable monofilament orpolyfilament material as will be apparent to persons skilled in the artin view of the teachings herein.

As shown in the present example, suture (682) extends in a zig-zagpattern from a proximal portion of cartridge deck (641) toward distalend of cartridge deck (641). Particularly, suture (682) on each side ofslot (660) passes over each staple cavity (645) once. As shown, startingat the proximal-most cavity (645), each suture (682) extends in arepeating pattern distally and medially (toward slot (660)) such thatthe suture (682) extends over an adjacent cavity (645), and distally andlaterally (away from slot (660)) back over the adjacent cavity (645). Inthe example shown, at least a portion of suture (682) is removablyadhered to cartridge deck (641). However, in other examples, suture(582) may be affixed to cartridge deck (641) by other suitable methods.Other suitable configurations of suture (682) will be apparent topersons skilled in the art in view of the teachings herein.

FIGS. 17 and 18 shows suture (682) and staples (685) coupled to a lowercolon portion (LC) after an end effector (1100) that was loaded withstaple cartridge (640) has been utilized to staple and sever a portionof lower colon portion (LC). In particular, FIG. 17 shows how suture(682) is secured to tissue by staples (685) in a zigzag arrangement. Inparticular, suture (682) extends along the full width of tissue, withfree ends (686) of suture (682) extending outwardly from flap regions(FR). It should be understood that suture (682) is captured between thecrowns of staples (685) and adjacent tissue; and that suture (682) maystill slide between the crowns of staples (685) and adjacent tissue.Suture (682) is thus secured to the tissue via staples (682) in a mannersimilar to a purse string weave.

FIG. 18 shows a step of an anastomosis procedure similar to the stepsshown in FIGS. 8 and 15A. Particularly, upper colon portion (UC) andlower colon portion (LC) have been severed and stapled in a similarmanner to that shown in FIGS. 7-8 and 15A-B. However, at least the lowercolon portion (LC) has been severed and stapled utilizing staplecartridge (640). Lower colon portion therefore includes staples (685)and suture (682) coupled thereto in the manner discussed above. Asshown, a portion of shaft (210) and stapling head assembly (300) areinserted into the rectum (R) of the patient and into the lower portionof the colon (C). As also shown, the circular stapler (10) of thisexample includes a modified trocar (1330) that is substantiallyidentical to trocar (330), except that trocar (1330) includes a lateralaperture (1331) formed therein. In the example shown, trocar (1330) isinserted through the line of staples (685) such that trocar (1330) isexposed out of lower colon portion (LC). Trocar (1330) and lower colonportion (LC) are further positioned in relation to each other such thatlateral aperture (1331) is exposed relative to lower colon portion (LC).

Anvil (400) is shown to be positioned in the upper portion (UC) of thecolon (C), with shank (420) extending through an opening of the uppercolon portion (UC). As shown, ends (686) of suture (682) are pulled tocause the stapled tissue to bunch up, such that flap regions (FR) arebrought toward each other and such that the tissue defines an effectivewidth (d) that is smaller than the diameter (b) of knife member (340).Thus, staples (685), suture (682), and flap regions (FR) are allpositioned within the cylindrical plane defined by knife member (340).The operator then pulls ends (686) of suture (682) through lateralaperture (1331) of trocar (1330), and secures ends (686) relative totrocar (1330) by tying a knot (688). Knot (688) thus cooperates withtrocar (1330) to hold the tissue in the bunched up configuration,thereby maintaining the effective width (d). Other suitable ways inwhich suture (682) may be secured relative to trocar (1330) will beapparent to persons skilled in the art in view of the teachings herein.

The operator then connects shank (420) to trocar (1330) in the mannerdiscussed above. Alternatively, the user may draw the tissue of lowercolon portion and the line of staples (585) radially inwardly and couplesuture (682) relative to trocar (1330) after shank (420) and trocar(1330) are coupled to one another. The operator may then draw anvil(400) toward stapling head assembly (300), in the manner described above(e.g., utilizing knob (130)), thus also drawing the upper colon portion(UC) toward the lower colon portion (LC). The operator may then retracttrocar (1330) until the tissue of the upper colon portion (UC) and thelower colon portion (LC) are compressed against the deck member (320) toachieve a desirable gap distance, in a similar manner as shown in FIG.15B.

The operator may then actuate trigger (150) to actuate stapling headassembly (300), resulting in the stapling and severing of tissue in asimilar manner as shown in FIG. 9. Due to the staples (685), suture(682), and flap regions (FR) all being positioned within the cylindricalplane defined by knife member (340), the combination of staples (685),suture (682), and flap regions (FR) are all severed from the adjacenttissue. Thus, no staples (685) or suture (682) are disposed in thetissue that remains at the resulting anastomosis site. Moreover, staples(685) do not impede the successful operation of circular stapler (10),and there are no flap regions (FR) extending outwardly from theanastomosis site. The severed portion of tissue including staples (685)and suture (682) may be removed by the operator via the patient'srectum.

C. Exemplary Alternative Staple Cartridge Including Buttress withIntegral Sutures for Securing Stapled Tissue to Trocar

FIG. 19 shows an exemplary alternative staple cartridge (740) insertedin first jaw (1112) of end effector (1110). Staple cartridge (740) issubstantially similar to staple cartridge (1140), except that staplecartridge (740) includes two rows of staple cavities (not shown) on eachside of a slot (760) of instead of three rows. Moreover, staplecartridge (740) includes a buttress (750) that is removably secured to adeck (741) of cartridge (740). Various suitable forms that the body ofbuttress (750) may take will be apparent to those of ordinary skill inthe art in view of the teachings herein. By way of example only, thebody of buttress (750) may be formed by a mesh of woven material that isprovided in the form of a thin sheet.

Buttress (750) includes an integral pair of proximal sutures (782 a) andan integral pair of distal sutures (782 b). Sutures (782 a, 782 b) areformed as strands having free ends that may be manipulated in the mannerdescribed below. In the example shown, buttress (750) is removablyadhered to deck (741), but in other examples buttress (750) may beassociated with or coupled to cartridge (740) in a different manner(e.g., via clips, via hook and loop fasteners, etc.). When an endeffector (1110) that incorporates staple cartridge (740) is actuated,buttress (750) will be severed along slot (760) and stapled onto tissuealong with staples (785), as shown best in FIG. 20A.

FIGS. 20A-20B show certain steps of an anastomosis procedure that issubstantially similar to the procedure shown in FIGS. 7-10 and 15A-C.Particularly, at the stage shown in FIG. 20A, upper colon portion (UC)and lower colon portion (LC) have been severed and stapled in a mannersimilar to that shown in FIGS. 7-8, 15A, and 18. However, at least thelower colon portion (LC) has been severed and stapled utilizing staplecartridge (740) in this example. Lower colon portion (LC) thereforeincludes staples (785) and buttress (750) coupled thereto in the mannerdiscussed above. As shown, a portion of shaft (210) and stapling headassembly (300) are inserted into the rectum (R) of the patient and intothe lower portion (LC) of the colon (C). As also shown, circular stapler(10) of this example includes a modified trocar (2330) that issubstantially identical to trocar (330), except that trocar (2330) ofthis example includes a lateral aperture (2331). The relative placementof aperture (2331) on trocar (2330) is more proximal than the placementof aperture (1331) on trocar (1330), which is discussed in furtherdetail below. In the example shown, trocar (2330) is inserted throughthe line of staples (785) such that trocar (2330) is exposed out oflower colon portion (LC). Trocar (2330) and lower colon portion (LC) arefurther positioned in relation to each other such that lateral aperture(2331) is exposed relative to lower colon portion (LC).

Anvil (400) is shown to be positioned in the upper portion (UC) of thecolon (C), with shank (420) extending through an opening of the uppercolon portion (UC). The operator then connects shank (420) to trocar(2330) in a similar manner as discussed above with respect to shank(420) and trocar (330). Before or after the shank (420) and trocar(2330) are coupled to one another, the operator may couple the distaland proximal sutures (782 a, 782 b) to trocar (2330) via aperture(2331). In the example shown, aperture (2331) is in an accessible distalposition (FIG. 20A) prior to the anvil (400) being drawn toward staplinghead assembly (300); and retractable to a less accessible, proximalposition (FIG. 20B). Due to the coupling between sutures (782 a, 782 b),as the operator draws anvil (400) toward stapling head assembly (300) tothe position shown in FIG. 20B (e.g., utilizing knob (130)), sutures(782 a, 782 b) are drawn proximally. As sutures (782 a, 782 b) are drawnproximally, sutures (782 a, 782 b) draw the respective proximal anddistal portions of buttress (750) proximally and radially inwardlyrelative to stapling head assembly (300). This results in staples (785),buttress (750), and the associated flap regions (FR) being positionedwithin the cylindrical plane defined by knife member (340), as shown inFIG. 20B.

The operator may then actuate trigger (150) to actuate stapling headassembly (300), resulting in the stapling and severing of tissue in asimilar manner as shown in FIG. 9. Due to staples (785), buttress (750),and the associated flap regions (FR) all being positioned within thecylindrical plane defined by knife member (340), the combination ofstaples (785), buttress (750), and the associated flap regions (FR) areall severed from the adjacent tissue. Thus, no staples (785) aredisposed in the tissue that remains at the resulting anastomosis site.Moreover, staples (785) do not impede the successful operation ofcircular stapler (10), and there are no flap regions (FR) extendingoutwardly from the anastomosis site. The severed portion of tissueincluding staples (785) and buttress (750) may be removed by theoperator via the patient's rectum.

It should be understood that the foregoing example provides cinching oftissue, and thus drawing-in of flap regions (FR) based on the proximalretraction of anvil (400) toward stapling head assembly (300). Asanother merely illustrative variation, as shown in FIG. 21, sutures(782) may be fed through stapling head assembly (300) and may be pulledproximally by the operator. In particular, FIG. 21 shows an alternativecircular stapler (1010) that includes a lumen (1012) into which sutures(782 a, 782 b) may be directed. Lumen (1012) is communication with anopening (not shown) that provides the operator with access to sutures(782 a, 782 b) and thereby enables the operator to pull proximally onsutures (782 a, 782 b) in order to draw the lines of staples (785) andthe lower colon portion (LC) radially inwardly toward trocar (330). Asshown, sutures (782 a, 782 b) are pulled in a manner sufficient to causethe stapled tissue to bunch up, such that flap regions (FR) are broughttoward each other and such that the tissue defines an effective width(e) that is smaller than the diameter (b) of knife member (340). Thus,staples (785), buttress (750), and the associated flap regions (FR) areall positioned within the cylindrical plane defined by knife member(340) as described above. Other suitable ways in which sutures (782 a,782 b) may be manipulated to draw staples (785), buttress (750), and theassociated flap regions (FR) within the cylindrical plane defined byknife member (340) will be apparent to those of ordinary skill in theart in view of the teachings herein.

D. Exemplary Alternative Staple Cartridge Including Buttress withIntegral Grommets for Securing Stapled Tissue to Trocar

FIG. 22 shows another exemplary alternative staple cartridge (840)inserted in first jaw (1112) of end effector (1110). Staple cartridge(840) is substantially similar to staple cartridge (1140), except thatstaple cartridge (840) includes two rows of staple cavities (not shown)on each side of a slot (860) of instead of three rows. Moreover, staplecartridge (840) includes a buttress (850) that is removably secured to adeck (841) of cartridge (840). Various suitable forms that the body ofbuttress (850) may take will be apparent to those of ordinary skill inthe art in view of the teachings herein. By way of example only, thebody of buttress (850) may be formed by a mesh of woven material that isprovided in the form of a thin sheet.

Buttress (850) includes an integral pair of proximal grommets (890 a)and an integral pair of distal grommets (890 b). Grommets (890 a, 890 b)are formed as reinforced openings through the body of buttress (850). Inthe example shown, buttress (850) is removably adhered to deck (841),but in other examples buttress (750) may be associated with or coupledto cartridge (840) in a different manner (e.g., via clips, via hook andloop fasteners, etc.). When an end effector (1110) that incorporatesstaple cartridge (840) is actuated, buttress (850) will be severed alongslot (860) and stapled onto tissue along with staples (885), as shownbest in FIG. 23.

FIG. 23 shows a portion of an anastomosis procedure that issubstantially similar to the procedure shown in FIGS. 7-10 and 15A-C.Particularly, upper colon portion (UC) and lower colon portion (LC) havebeen severed and stapled in a similar manner to that shown in FIGS. 7-8,15A, 18, 20A, and 21. However, at least the lower colon portion (LC) hasbeen severed and stapled utilizing staple cartridge (840). Lower colonportion (LC) therefore includes staples (885) and buttress (850) coupledthereto in the manner discussed above. As shown, a portion of shaft(210) and stapling head assembly (300) are inserted into the rectum (R)of the patient and into the lower portion of the colon (C). As alsoshown, circular stapler (10) of this example includes a modified trocar(3330) that is substantially identical to trocar (330), except thattrocar (2330) of this example includes an opposing set of outwardlyprojecting hooks (3332). In the example shown, trocar (2330) is insertedthrough the line of staples (785) such that trocar (3330) is exposed outof lower colon portion (LC). Trocar (3330) and lower colon portion (LC)are further positioned in relation to each other such that hooks (3332)are exposed relative to lower colon portion (LC).

Anvil (400) is shown to be positioned in the upper portion (UC) of thecolon (C), with shank (420) extending through an opening of the uppercolon portion (UC). The operator then connects shank (420) to trocar(2330) in a similar manner as discussed above with respect to shank(420) and trocar (330). Before or after the shank (420) and trocar(2330) are coupled to one another, the operator may engage the distaland proximal grommets (890 a, 890 b) with respective hooks (3332) oftrocar (3330). Alternatively, grommets (890 a, 890 b) may be engagedwith only one hook (3332) of trocar (3330). As shown in FIG. 23, line ofstaples (885) and portion of the lower colon portion (LC) are drawnradially inwardly toward trocar (3330) due to coupling between grommets(890 a, 890 b) and hooks (3332). As the operator retracts anvil (400)toward stapling head assembly (300) to clamp tissue, the proximallyretracting trocar (3300) draws the tissue at the severed end of lowercolon section (LC) inwardly. In particular, grommets (890 a, 890 b) arepulled in a manner sufficient to cause the stapled tissue to bunch up,such that flap regions (FR) are brought toward each other and such thatthe tissue defines an effective width (f) that is smaller than thediameter (b) of knife member (340). Thus, staples (885), buttress (850),and the associated flap regions (FR) are all positioned within thecylindrical plane defined by knife member (340) as described above.Other suitable ways in which grommets (890 a, 890 b) may be manipulatedto draw staples (885), buttress (850), and the associated flap regions(FR) within the cylindrical plane defined by knife member (340) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

After the operator has drawn in the tissue at the severed end of lowercolon section (LC), and after the operator has clamped tissue with anappropriate gap between anvil (400) and stapling head assembly (300),the operator may actuate trigger (150) to actuate stapling head assembly(300), resulting in the stapling and severing of tissue in a similarmanner as shown in FIGS. 9 and 15C. As with the example shown in FIGS.15A-C, due to staples (885), buttress (850), and the associated flapregions (FR) all being positioned within the cylindrical plane definedby knife member (340), the combination of staples (885), buttress (850),and the associated flap regions (FR) are all severed from the adjacenttissue. Thus, no staples (885) are disposed in the tissue that remainsat the resulting anastomosis site. Moreover, staples (885) do not impedethe successful operation of circular stapler (10), and there are no flapregions (FR) extending outwardly from the anastomosis site. The severedportion of tissue including staples (885) and buttress (850) may beremoved by the operator via the patient's rectum.

III. EXEMPLARY COMBINATIONS

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

An apparatus comprising a staple cartridge, wherein the staple cartridgecomprises: (i) a plurality of staples, (ii) a deck, wherein the deckdefines a plurality of openings, wherein each opening of the pluralityof openings is associated with a corresponding staple of the pluralityof staples, such that each staple is configured to pass through acorresponding opening of the plurality of openings, and (ii) a cinchingfeature positioned on the deck, wherein the cinching feature isconfigured to be coupled to tissue in response to actuation of thestaple cartridge, wherein the cinching feature is configured to cinch aportion of stapled tissue toward an inwardly cinched position.

Example 2

The apparatus of Example 1, wherein the cinching feature comprises atleast one suture positioned over at least some of the staple openings.

Example 3

The apparatus of Example 2, wherein the at least one suture extends overeach of the staple openings.

Example 4

The apparatus of any one or more of Examples 2 through 3, wherein thecinching feature further comprises a plurality of suture retainersoperably coupled to the suture.

Example 5

The apparatus of any one or more of Examples 2 through 4, wherein thedeck comprises a slot, wherein the at least one suture comprises a firstsuture positioned on a first side of the slot and a second suturepositioned on a second side of the slot.

Example 6

The apparatus of any one or more of Examples 1 through 5, wherein thecinching feature is adhered to the deck.

Example 7

The apparatus of any one or more of Examples 1 through 6, wherein thecinching feature comprises a buttress disposed on the deck.

Example 8

The apparatus of Example 7, wherein the buttress comprises at least onesuture coupled thereto.

Example 9

The apparatus of any one or more of Examples 7 through 8, wherein thebuttress comprises a proximal end and a distal end, wherein the proximalend includes a pair of opposing sutures and the distal end includes apair of opposing sutures.

Example 10

The apparatus of any one or more of Examples 7 through 9, wherein thebuttress is configured to be severed in response to activation of thesevering and stapling assembly.

Example 11

The apparatus of any one or more of Examples 7 through 10, wherein thebuttress comprises at least one aperture.

Example 12

The apparatus of any one or more of Examples 7 through 11, wherein thebuttress comprises a proximal end and a distal end, wherein the proximalend includes a pair of opposing apertures and the distal end includes apair of opposing apertures.

Example 13

The apparatus of any one or more of Examples 1 through 12, furthercomprising a circular stapler, wherein the circular stapler comprises:(i) an anvil, and (ii) a stapling head assembly, wherein the staplinghead assembly comprises: (A) a rod configured to engage the anvil, (B) aknife member configured to form a circular cut line in tissue, and (C) astaple driver, wherein the anvil and stapling head assembly areconfigured to cooperate to clamp and staple tissue; wherein the cinchingfeature is configured to be coupled to the rod when the circular stapleris associated with tissue stapled and severed by the apparatus.

Example 14

The apparatus of Example 13, wherein the rod includes an apertureconfigured to receive a portion of the cinching feature.

Example 15

The apparatus of any one or more of Examples 13 through 14, wherein therod includes at least one hook configured to engage a portion of thecinching feature

Example 16

A method of operating on tissue using a circular stapler, wherein thecircular stapler comprises an anvil and a stapling head assembly,wherein the stapling head assembly comprises a rod, a knife member, anda staple driver, wherein the knife member defines a circular cut line,wherein the anvil and stapling head assembly are configured to cooperateto clamp and staple tissue, wherein the method comprises: (a) severingand stapling a first portion of anatomical structure using anon-circular stapler, thereby leaving a plurality of staples on asevered end portion of the first portion of an anatomical structure; (b)inserting the anvil of the circular stapler into a second portion of theanatomical structure; (c) inserting the stapling head assembly into thefirst portion of the anatomical structure until at least a portion ofthe rod extends past the severed end portion of the first portion of theanatomical structure; (d) drawing the severed end portion inwardlytoward the rod such that the plurality of staples on the severed endportion lie inward of the circular cut line of the knife member; (e)coupling the rod and the anvil; (f) clamping the first and secondportions of the anatomical structure together; and (g) driving the knifemember toward the anvil, thereby severing the severed end portion andthe staples from the first portion of the anatomical structure and atleast part of the second portion of the anatomical structure; and (h)stapling the first and second portions of the anatomical structuretogether.

Example 17

The apparatus of Example 16, wherein the first portion of the anatomicalstructure comprises a first portion of a colon, wherein the secondportion of the anatomical structure comprises a second portion of thecolon.

Example 18

A method of forming an anastomosis between two portions of a colon usinga circular stapler, wherein the circular stapler comprises an anvil anda stapling head assembly, wherein the stapling head assembly comprises arod, a knife member, and a staple driver, wherein the knife memberdefines a circular cut line, wherein the anvil and stapling headassembly are configured to cooperate to clamp and staple tissue, whereinthe method comprises: (a) severing and stapling a first portion of thecolon using a non-circular stapler, thereby leaving a first plurality ofstaples on a first severed end portion of the first portion of thecolon; (b) severing and stapling a second portion of the colon using anon-circular stapler, thereby leaving a second plurality of staples on asecond severed end portion of the second portion of the colon; (c)inserting the anvil of the circular stapler into the second portion ofthe patient's colon; (d) inserting the stapling head assembly into thefirst portion of the colon until at least a portion of the rod extendspast the severed end portion of the first anatomical structure; (e)drawing the first severed end portion inwardly toward the rod such thatthe first plurality of staples and the first severed end portion lieradially inwardly of the circular cut line of the knife member; (f)driving the knife member toward the anvil, thereby severing the firstsevered end portion and the first plurality of staples from the firstportion of the patient's colon and at least part of the second portionof the patient's colon; and (g) stapling the first and second portionsof the colon together.

Example 19

The method of Example 18, wherein drawing the first severed end portioninwardly toward the rod further comprises cinching the first severed endportion toward the rod.

Example 20

The system of any one or more of Examples 18 through 19, whereinsevering and stapling the first portion of the colon further comprisesimplanting a suture onto the first severed end portion such that thesuture is configured to act as a purse string, wherein the act ofdrawing the first severed end portion inwardly toward the rod comprisespulling the implanted suture.

IV. Miscellaneous

It should also be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

At least some of the teachings herein may be readily combined with oneor more teachings of U.S. Pat. No. 7,794,475, entitled “Surgical StaplesHaving Compressible or Crushable Members for Securing Tissue Therein andStapling Instruments for Deploying the Same,” issued Sep. 14, 2010, thedisclosure of which is incorporated by reference herein; U.S. Pub. No.2014/0151429, entitled “Trans-Oral Circular Anvil Introduction Systemwith Dilation Feature,” published Jun. 5, 2014, the disclosure of whichis incorporated by reference herein; U.S. Pub. No. 2014/0144968,entitled “Surgical Staple with Integral Suture retainer for TipDeflection,” published May 29, 2014, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2014/0158747, entitled“Surgical Stapler with Varying Staple Widths along DifferentCircumferences,” published Jun. 12, 2014, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2014/0144969, entitled“Pivoting Anvil for Surgical Circular Stapler,” published May 29, 2014,the disclosure of which is incorporated by reference herein; U. S. Pub.No. 2014/0151430, entitled “Circular Anvil Introduction System withAlignment Feature,” published Jun. 5, 2014, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2014/0166717, entitled“Circular Stapler with Selectable Motorized and Manual Control,Including a Control Ring,” published Jun. 19, 2014, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2014/0166728,entitled “Motor Driven Rotary Input Circular Stapler with Modular EndEffector,” published Jun. 19, 2014, the disclosure of which isincorporated by reference herein; and/or U.S. Pub. No. 2014/0166718,entitled “Motor Driven Rotary Input Circular Stapler with LockableFlexible Shaft,” published Jun. 19, 2014, the disclosure of which isincorporated by reference herein. Various suitable ways in which suchteachings may be combined will be apparent to those of ordinary skill inthe art.

While the examples herein have been provided in the context of acircular stapling instrument, it should be understood that the variousteachings herein may be readily applied to various other kinds ofsurgical instruments. By way of example only, the various teachingsherein may be readily applied to linear stapling devices (e.g.,endocutters). For instance, various teachings herein may be readilycombined with various teachings of U.S. Pub. No. 2012/0239012, entitled“Motor-Driven Surgical Cutting Instrument with Electric ActuatorDirectional Control Assembly,” published Sep. 20, 2012, the disclosureof which is incorporated by reference herein, and/or U.S. Pub. No.2010/0264193, entitled “Surgical Stapling Instrument with AnArticulatable End Effector,” published Oct. 21, 2010, the disclosure ofwhich is incorporated by reference herein, as will be apparent to thoseof ordinary skill in the art. As another merely illustrative example,the various teachings herein may be readily applied to a motorizedelectrosurgical device. For instance, various teachings herein may bereadily combined with various teachings of U.S. Pub. No. 2012/0116379,entitled “Motor Driven Electrosurgical Device with Mechanical andElectrical Feedback,” published May 10, 2012, the disclosure of which isincorporated by reference herein, as will be apparent to those ofordinary skill in the art. Other suitable kinds of instruments in whichthe teachings herein may be applied, and various ways in which theteachings herein may be applied to such instruments, will be apparent tothose of ordinary skill in the art.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.

Versions described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by a userimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1-20. (canceled)
 21. A method of forming an anastomosis between firstand second tissue structure portions with a first surgical stapler and asecond surgical stapler, wherein the second surgical stapler includes ananvil and a stapling head assembly having an elongate member and acylindraceous knife member, the method comprising: (a) stapling andsevering a tissue structure with the first surgical stapler and therebyyielding: (i) a first tissue structure portion having a first closedend, wherein the first closed end includes a first array of staples anda cinching feature secured to the tissue by the first array of staples,and (ii) a second tissue structure portion having a second closed end;(b) inserting the anvil of the second surgical stapler into the secondtissue structure portion; (c) inserting the stapling head assembly intothe first tissue structure portion until at least a portion of theelongate member extends beyond the first closed end; (d) drawing thefirst closed end radially inwardly toward the elongate member with thecinching feature such that the first array of staples and the cinchingfeature are disposed radially inwardly of the cylindraceous knifemember; (e) coupling the anvil to the elongate member; (f) clamping thefirst and second tissue structure portions between the anvil and thestapling head assembly; (g) cutting the clamped first and second tissuestructure portions with the cylindraceous knife member and therebyforming an anastomosis therebetween; and (h) stapling the clamped firstand second tissue structure portions together.
 22. The method of claim21, wherein drawing the first closed end radially inwardly toward theelongate member includes providing the first closed end with aneffective width smaller than a diameter of the cylindraceous knifemember.
 23. The method of claim 21, wherein cutting the clamped firstand second tissue structure portions with the cylindraceous knife memberincludes severing the first array of staples and the cinching featurefrom the first tissue structure portion.
 24. The method of claim 21,wherein the first surgical stapler comprises a non-circular stapler. 25.The method of claim 21, further comprising: (a) coupling the cinchingfeature with the elongate member; and (b) retracting the elongate memberproximally and thereby drawing the first closed end proximally via thecinching feature.
 26. The method of claim 25, wherein the cinchingfeature includes a suture, wherein the elongate member includes anaperture, wherein coupling the cinching feature with the elongate memberincludes directing the suture through the aperture.
 27. The method ofclaim 25, wherein the cinching feature includes a buttress, whereincoupling the cinching feature with the elongate member includes couplingthe buttress with the elongate member.
 28. The method of claim 27,wherein the elongate member includes a projection, wherein coupling thebuttress with the elongate member includes engaging a portion of thebuttress with the projection.
 29. The method of claim 21, wherein thecinching feature includes a buttress.
 30. The method of claim 21,wherein the cinching feature includes a suture.
 31. The method of claim30, further comprising directing an end of the suture proximally throughthe stapling head assembly before clamping the first and second tissuestructure portions.
 32. The method of claim 21, wherein the firstsurgical stapler includes a staple cartridge having a deck configured tocontact tissue, wherein the cinching feature is positioned on the deck.33. The method of claim 32, wherein the staple cartridge includes aplurality of openings that house staples, wherein the cinching featurecovers at least some of the openings.
 34. The method of claim 32,wherein the cinching feature includes a suture and a plurality ofretainer elements that couple the suture to the deck.
 35. The method ofclaim 21, wherein the cinching feature is adhered to the deck.
 36. Amethod of forming an anastomosis between first and second tissuestructure portions with a first surgical stapler and a second surgicalstapler, wherein the second surgical stapler includes an anvil and astapling head assembly having an elongate member and a cylindraceousknife member, the method comprising: (a) stapling and severing a tissuestructure with the first surgical stapler and thereby yielding: (i) afirst tissue structure portion having a first closed end, wherein thefirst closed end includes a first array of staples and a cinchingfeature secured to the tissue by the first array of staples, and (ii) asecond tissue structure portion having a second closed end; (b)inserting the anvil of the second surgical stapler into the secondtissue structure portion; (c) inserting the stapling head assembly intothe first tissue structure portion until at least a portion of theelongate member extends beyond the first closed end; (d) drawing thefirst closed end radially inwardly toward the elongate member andthereby providing the first closed end with an effective width smallerthan a diameter of the cylindraceous knife member; (e) coupling theanvil to the elongate member; (f) clamping the first and second tissuestructure portions between the anvil and the stapling head assembly; (g)cutting the clamped first and second tissue structure portions with thecylindraceous knife member and thereby forming an anastomosistherebetween; and (h) stapling the clamped first and second tissuestructure portions together.
 37. The method of claim 36, wherein thecinching feature includes a suture.
 38. A method of forming ananastomosis between first and second tissue structure portions with afirst surgical stapler and a second surgical stapler, wherein the secondsurgical stapler includes an anvil and a stapling head assembly havingan elongate member and a cylindraceous knife member, the methodcomprising: (a) stapling and severing a tissue structure with the firstsurgical stapler and thereby yielding: (i) a first tissue structureportion having a first closed end, wherein the first closed end includesa first array of staples and a cinching feature secured to the tissue bythe first array of staples, and (ii) a second tissue structure portionhaving a second closed end; (b) inserting the anvil of the secondsurgical stapler into the second tissue structure portion; (c) insertingthe stapling head assembly into the first tissue structure portion untilat least a portion of the elongate member extends beyond the firstclosed end; (d) coupling the anvil to the elongate member; (e) couplingthe cinching feature with the elongate member; (f) retracting theelongate member proximally and thereby: (i) drawing the first closed endradially inwardly toward the elongate member via the cinching feature,and (ii) clamping the first and second tissue structure portions betweenthe anvil and the stapling head assembly; (g) cutting the clamped firstand second tissue structure portions with the cylindraceous knife memberand thereby forming an anastomosis therebetween; and (h) stapling theclamped first and second tissue structure portions together.
 39. Themethod of claim 38, wherein the cinching feature includes a buttress,wherein coupling the cinching feature with the elongate member includescoupling the buttress with the elongate member.
 40. The method of claim39, wherein the elongate member includes an aperture, wherein thecinching feature further includes a suture secured to the buttress,wherein coupling the buttress with the elongate member includesdirecting the suture through the aperture.